by Beth Miller, The (Wilmington, Del.) News Journal

by Beth Miller, The (Wilmington, Del.) News Journal

WILMINGTON, Del. -- When Debbie Krueger discovered her 17-year-old son had been smoking pot with his friends in their Dover, Del., home, she gave him two choices: He could go to rehab or he could move out.

"He took the option I didn't offer," she said, "the one I never even thought about."

A couple of nights later, exasperated by her son's continued drug use, Krueger called the police. While she was on the phone, Anthony walked into his mother's bedroom and locked the door. While waiting for police, Krueger heard two muffled bangs and called 911 again.

"Hurry," she said. "I think he's beating himself up in there."

The next thing she knew, Anthony was standing in the bedroom doorway covered with blood. Her .22-caliber handgun was on the bed.

Anthony had shot himself, just under his chin, twice.

That was Jan. 25, almost a year ago. Since then, the Krueger family has lived through a life-and-death challenge that scores of other Delaware families have had to face: the attempted suicide of a young family member.

A startling series of adolescent suicide deaths in Delaware's Kent and Sussex counties last year prompted state officials to ask the federal Centers for Disease Control and Prevention to study the situation. Last spring, the CDC identified a suicide cluster in those two counties: an area within a 25-mile radius where 11 residents ages 12-21 took their own lives from Jan. 11 to May 4.

The CDC said at least 116 other young people -- including Anthony -- attempted suicide during that same period.

"There's not many people who can be on the other side of this and talk about it," Debbie Krueger said.

But that needs to happen now, she said. Families are hurting, kids are hurting and the struggle to recover is essential. It's important to get a message to them -- and to the broader community, too, she said.

"Stay strong," she said. "And no matter what your kids are going through -- never, ever give up on them."

Complex problem

There are no easy answers. Death by suicide often reveals a complex web of contributing factors that could have been addressed in productive ways, experts say.

Four of the dead teens had been students at Polytech High School in Woodside, Del., but the CDC found no evidence of what it calls suicide contagion in its preliminary report, released in August. The report did say that mental health issues -- including depression, anxiety and prior suicidal thoughts -- were a factor in at least seven of the 11 cases. All had at least two risk factors gnawing at their lives -- things such as tension with family, romantic problems and school problems -- and the majority exhibited five factors or more.

Those findings track with national patterns, said Dr. Paula Clayton, a psychiatrist and medical director at the American Foundation for Suicide Prevention. Clayton said research shows 90 percent of those who commit suicide had a mental disorder at the time of their death. Either their treatment wasn't working or the disorder was unrecognized and untreated.

"Most of these kids were not just distressed for one reason or another," she said. "All have precipitants -- maybe some kind of humiliation, a breakup, bullying -- some kind of final straw. Underneath that, the kids usually are depressed, and that makes them more vulnerable."

Struggle to survive

Anthony has little memory of the day he shot himself. He doesn't remember the month before it, either. And most of the four months that followed were spent in the fog of a hospital.

He recalls a few things he was struggling with, though. He had broken up with a girl. His dad was not part of his life. He had totaled his mom's car on New Year's Day.

He was at odds with his mom again and didn't know what he would do if she actually kicked him out of the house. He was feeling bad about his life, "maybe a little bit depressed," he said.

And then there was the Percocet.

Debbie Krueger knew about the pot but did not know Anthony was shooting Percocet until she learned that needles and a pill crusher had been found in his bedroom.

"I was freaking flipped out," he said. "I didn't know where to go, what to do, how to get a job. That wasn't this mind thinking."

Anthony was familiar with weapons. His mother had spent four years in the Marine Corps, and the family often did target shooting outside their Hartly, Del., home before she and Anthony's father divorced.

His father did not respond to requests to be interviewed.

When Debbie Krueger moved with Anthony and his three younger sisters to Dover, she kept that .22 ready. Anthony knew where it was, she said, so he could defend the family when she was gone, and, while working three jobs to support the family, she often was gone.

The gun is no longer in the house. "I had the police dispose of it," Debbie Krueger said.

She knows she almost lost him, though.

It was touch and go for a long time. Someone told her Anthony could hear her, even though he was unconscious. So she made it a point to say something "good and positive" to him every day. That approach helped her, too, as she tried to navigate the nightmare that threatened her family.

"The whole time he was lying in that bed, I told him, 'You're going to make it. We're going to come through this. We're going to be happy again.' "

Getting help

Delaware soon will release the CDC's final report on the suicide cluster in Kent and Sussex counties. Officials say it will provide greater details about the 11 deaths.

But the estimated 116 young people who survived a suicide attempt during that time period face new challenges, as do their families and friends.

"There's no central reporting to this division, so we don't know about those 116 unless one of those families or students contacted us individually."

So Dunleavy and others have fanned out to take suicide prevention and awareness programs throughout the state.

It has been tough, he said, to get parents to participate.

Many are ill-equipped to know how to respond when someone they know and love reaches what feels like a breaking point. Others can't imagine such a thing could happen in their household.

"You have to come right out and say there should be no shame," said Clayton, the psychiatrist with the American Foundation for Suicide Prevention.

Some families refuse to acknowledge what has happened or to address the underlying factors that put a person at risk for suicide.

Those who survive an attempt should be evaluated by a mental health professional, Clayton said. And all parents and caretakers should keep an eye out for changes in a child.

Deciding to get help can be a tough decision, she said.

"But they shouldn't feel shame about it. They should feel concern because these kids are suffering. If you think of (Abraham) Lincoln -- he had depression. (Winston) Churchill had depression. Football players have depression. Movie stars like Carrie Fisher write about their bipolar illnesses. There are lots of people who are very successful who have had mental disorders."

Not all who attempt suicide have mental disorders, and many with mental illness never attempt suicide. But the possible connection must be considered.

'Raise ... red flags'

The cluster of loss last spring sounded an alarm that more must be done to help kids get through whatever they are facing.

But the CDC noted a number of obstacles in the area they studied -- limited activities for kids outside of school, limited mental health resources, lack of transportation, resistance to mental health treatment, inappropriate access to firearms and limited training and awareness of the issues.

Experts say one caring adult can make all the difference for a kid. And the training that students receive in classes now tells them that three "strong connections" will help them be safe.

"If you know a teen involved in drugs or alcohol, someone who has a family situation that is not conducive to a good lifestyle, raise those red flags," Debbie Krueger said.

For those who have lived through the trauma of a suicide attempt, recovery often is more a direction than a destination.

"Sometimes clients are very frustrated that they have not healed enough," said Joseph Zingaro, a Milford, Del., psychologist. "Healing doesn't mean you're numb. That's what anesthesia is for. Healing means you go forward because you're different from what was before."

Anthony Krueger is different. He said he doesn't know how he survived his suicide attempt. But he thinks he knows why.

"I was put here for a reason," he said. "And I have to live that reason."